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Landrum O, Marcondes L, Egharevba T, Gritsenko K. Painful diabetic peripheral neuropathy of the feet: integrating prescription-strength capsaicin into office procedures. Pain Manag 2023; 13:613-626. [PMID: 37750226 DOI: 10.2217/pmt-2023-0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023] Open
Abstract
Prescription-strength (8%) capsaicin topical system is a US FDA-approved treatment for painful diabetic peripheral neuropathy of the feet. A 30 min application of the capsaicin 8% topical system can provide sustained (up to 3 months) local pain relief by desensitizing and reducing TRPV1-expressing cutaneous fibers. Capsaicin is not absorbed systemically; despite associated application-site discomfort, capsaicin 8% topical system is well tolerated, with no known drug interactions or contraindications, and could offer clinical advantages over oral options. Capsaicin 8% topical system are not for patient self-administration and require incorporation into office procedures, with the added benefit of treatment compliance. This article reviews existing literature and provides comprehensive, practical information regarding the integration of capsaicin 8% topical systems into office procedures.
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Affiliation(s)
- Orlando Landrum
- Regenerative Medicine & Interventional Pain Specialist, Cutting Edge Integrative Pain Centers, 3060 Windsor Cir, Elkhart, IN 46514, USA
| | - Lizandra Marcondes
- Averitas Pharma, Inc., Morristown, 360 Mt Kemble Ave, Morristown, NJ 07960, USA
| | - Toni Egharevba
- Averitas Pharma, Inc., Morristown, 360 Mt Kemble Ave, Morristown, NJ 07960, USA
| | - Karina Gritsenko
- Montefiore Medical Center, New 111 E 210th St, Bronx, NY 10467, USA
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Adegbola A, Gritsenko K, Medrano EM. Perioperative Use of Ketamine. Curr Pain Headache Rep 2023; 27:445-448. [PMID: 37392333 DOI: 10.1007/s11916-023-01128-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2023] [Indexed: 07/03/2023]
Abstract
PURPOSE OF REVIEW Postoperative pain continues to be one of the most common challenges following surgeries. Multimodal analgesia has been of particular focus as non-opioid alternatives have been encouraged due to concerns of the opioid epidemic. Ketamine has been an especially useful adjunct in multimodal pain regimens within the past few decades. This article highlights the current use and advances surrounding the perioperative use of ketamine. RECENT FINDINGS Ketamine has antidepressive effects at subanesthetic doses. Intraoperative ketamine may be beneficial in reducing postoperative depression. Additionally, newer studies are exploring whether ketamine can be useful in reducing postoperative sleep disturbances. Ketamine continues to be a great tool in perioperative pain control, especially during an opioid epidemic. As its use continues to expand and gain more popularity in the perioperative period, more research could shed light on the additional nonanalgesic benefits of ketamine use.
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Affiliation(s)
- Abimbola Adegbola
- Montefiore Medical Center, 111 E 210Th Street, Bronx, NY, 10467, USA.
| | - Karina Gritsenko
- Montefiore Medical Center, 111 E 210Th Street, Bronx, NY, 10467, USA
- Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Elilary Montilla Medrano
- Montefiore Medical Center, 111 E 210Th Street, Bronx, NY, 10467, USA
- Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
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Slinchenkova K, Lee K, Choudhury S, Sundarapandiyan D, Gritsenko K. A Review of the Paravertebral Block: Benefits and Complications. Curr Pain Headache Rep 2023:10.1007/s11916-023-01118-1. [PMID: 37294514 DOI: 10.1007/s11916-023-01118-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE OF REVIEW Paravertebral nerve blocks (PVB) have experienced a surge over the past 2 decades as improved access to ultrasound has increased ease of performance. The purpose of this review is to identify recent findings with regard to PVB's uses, including benefits, risks, and recommendations. RECENT FINDINGS PVB is reported as an effective method of analgesia both in intraoperative and postoperative applications, with novel applications showing its potential to replace general anesthesia for certain procedures. The use of PVB as a method of analgesia postoperatively has shown lower opioid usage and faster PACU discharge, when compared to alternative approaches like the intercostal nerve block, erector spinae plane block, pectoralis II block, and patient-controlled analgesia. Thoracic epidural analgesia and a serratus anterior plane block are comparable to PVB and can be used as alternatives. The incidence of adverse events is consistently reported to be very low with few new risks being identified as the use of PVB expands. While there are worthwhile alternatives to PVB, it is an excellent option to consider, particularly for higher-risk patients. For patients undergoing thoracic or breast surgery, PVB can improve opioid usage and shorten the length of stay leading to an overall positive impact on patient recovery and satisfaction. More research is needed to further expand novel applications.
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Affiliation(s)
- Kateryna Slinchenkova
- Department of Anesthesiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA.
| | - Kay Lee
- Department of Anesthesiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Shivaditya Choudhury
- Department of Anesthesiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Divya Sundarapandiyan
- St.Vincent's Medical Center, Frank H. Netter School of Medicine at Quinnipiac University, Bridgeport, CT, USA
| | - Karina Gritsenko
- Department of Anesthesiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
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Breidenbach KA, Wahezi SE, Kim SY, Koushik SS, Gritsenko K, Shaparin N, Kaye AD, Viswanath O, Wu H, Kim JH. Contrast Spread After Erector Spinae Plane Block at the Fourth Lumbar Vertebrae: A Cadaveric Study. Pain Ther 2023; 12:241-249. [PMID: 36370257 PMCID: PMC9845450 DOI: 10.1007/s40122-022-00453-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/24/2022] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION In recent years, the erector spinae plane block (ESPB) has seen widespread use to treat acute and chronic pain in the regions of the thoracic spine. While limited data suggest its increasing utilization for pain management distal to the thoracic, abdomen and trunk, the anesthetic spread and analgesic mechanism of ESPB at the level of the lumbar spine has not been fully described or understood. METHODS This is an observational anatomic cadaveric study to assess the distribution of solution following an ESPB block performed at the fourth lumbar vertebrae (L4) using ultrasound guidance to evaluate the spread of a 20 ml solution consisting of local anesthetic and methylene blue. The study was performed in an anatomy lab in a large academic medical center. Following injection of local anesthetic with contrast dye, cadaveric dissection was performed to better understand the extent of contrast dye and to determine the degree of staining to further predict analgesic potential. We reviewed the findings of other ESPB cadaveric studies currently available for comparison. RESULTS Following cadaveric dissection in an anatomy lab, the contrast dye was observed in the ESP space, and staining was found most cranially at L2 and extending caudally underneath the sacrum. Evaluating the depth of its spread, we found it to be confined to the posterior compartment of the spine sparing the nerve roots bilaterally, which is consistent with the only other cadaveric study of ESPB performed at L4. CONCLUSION Our results demonstrate the clinical utility of lumbar ESPB where posterior confinement of local anesthesia is preferred. However, further investigation is needed to determine the efficacy of ESPB in lower extremity analgesia which is predicated on ventral nerve root involvement.
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Affiliation(s)
- Kathryn A. Breidenbach
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY USA
| | - Sayed E. Wahezi
- Department of Physical Medicine and Rehabilitation, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY USA
| | - Soo Yeon Kim
- Department of Physical Medicine and Rehabilitation, Icahn School of Medicine at Mount Sinai Hospital, New York, NY USA
| | - Sarang S. Koushik
- Department of Anesthesiology, Valleywise Health Medical Center, Creighton University School of Medicine, Phoenix, AZ USA
| | - Karina Gritsenko
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY USA
| | - Naum Shaparin
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY USA
| | - Alan D. Kaye
- Department of Anesthesiology, LSU Health Shreveport, Shreveport, LA USA
| | - Omar Viswanath
- Innovative Pain and Wellness, LSU Health Sciences Center School of Medicine, Creighton University School of Medicine, Phoenix, AZ USA
| | - Hall Wu
- Department of Anesthesiology and Pain Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA USA
| | - Jung H. Kim
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai West and Morningside Hospitals, New York, NY USA
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Patel A, Koushik S, Schwartz R, Gritsenko K, Farah F, Urits I, Varrassi G, Viswanath O, Shaparin N. Platelet-Rich Plasma in the Treatment of Facet Mediated Low Back Pain: A Comprehensive Review. Orthop Rev (Pavia) 2022; 14:37076. [PMID: 35910548 DOI: 10.52965/001c.37076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 05/21/2022] [Indexed: 11/06/2022] Open
Abstract
Background Facet-mediated pain is a major cause of low back pain and as a result, is a significant cause of morbidity, including disability and reduced functionality. Setting The present investigation involved a PubMed literature review between June 1, and 2021-January 1, 2022. Methods We systematically reviewed was carried Pubmed using the search terms "platelet-rich plasma", "inflammatory mediators", "facet arthropathy", "axial back pain", and "leukoreduction". Data extraction and quality assessment were performed by 3 independent reviewers. Out of the studies analyzed 2 were retrospective, while 1 was a prospective study. Results PRP injections for facet mediated or modulated pain are an alternative to conventional pharmacotherapies and interventional injections/radiofrequency. There are limited numbers of studies in world literature at present. Limitations Small number of articles in the world literature and small numbers of patients in those published studies. Conclusions At present, there are limited studies in the literature; however, larger well-designed studies are warranted to precisely understand efficacy, potential side effects and best practice techniques for PRP injections for facet mediated or modulated pain.
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Affiliation(s)
- Aakash Patel
- Montefiore Medical Center, Albert Einstein School of Medicine
| | - Sarang Koushik
- Valleywise Health Medical Center, Creighton University School of Medicine
| | - Ruben Schwartz
- Keck School of Medicine of USC, Department of Anesthesiology & Pain Medicine
| | | | - Fadi Farah
- Montefiore Medical Center, Albert Einstein School of Medicine
| | - Ivan Urits
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School
| | | | - Omar Viswanath
- LSU Health Sciences Center School of Medicine, Creighton University School of Medicine
| | - Naum Shaparin
- Montefiore Medical Center, Albert Einstein School of Medicine
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Champagne K, Date P, Forero JP, Arany J, Gritsenko K. Patients on Buprenorphine Formulations Undergoing Surgery. Curr Pain Headache Rep 2022; 26:459-468. [PMID: 35460492 DOI: 10.1007/s11916-022-01046-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To review the pharmacology of buprenorphine, the evolution of buprenorphine dosing recommendations, and the current literature regarding its recommendations for the perioperative period. RECENT FINDINGS There is a consensus that for all surgeries, buprenorphine should be continued throughout the perioperative period. If the surgery is a minimal to mild pain surgery, no dose adjustment is needed. There is no clear consensus regarding moderate to severe pain. With all surgeries, multimodal analgesia should be utilized, with regional anesthesia when possible. Patients taking buprenorphine should continue their buprenorphine perioperatively; whether to decrease or maintain dosing is up for debate. Multimodal analgesia should also be used throughout the perioperative period, and communication between the patient and all provider teams is of the utmost importance to provide adequate analgesia during the perioperative period, as well as to arrange safe analgesia upon discharge.
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Affiliation(s)
- Katelynn Champagne
- Department of Anesthesiology, Montefiore Medical Center, 111 East 210th St, Bronx, NY, 10467, USA
| | - Preshita Date
- Department of Anesthesiology, Montefiore Medical Center, 111 East 210th St, Bronx, NY, 10467, USA
| | - Juan Pablo Forero
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, 10461, USA
| | - Joshua Arany
- Townsend Harris High School, 149-11 Melbourne Ave, Flushing, NY, 11367, USA
| | - Karina Gritsenko
- Department of Anesthesiology, Montefiore Medical Center, 111 East 210th St, Bronx, NY, 10467, USA.
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, 10461, USA.
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Abd-Elsayed A, Strand N, Gritsenko K, Martens J, Chakravarthy K, Sayed D, Deer T. Radiofrequency Ablation for the Knee Joint: A Survey by the American Society of Pain and Neuroscience. J Pain Res 2022; 15:1247-1255. [PMID: 35509622 PMCID: PMC9057892 DOI: 10.2147/jpr.s342653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 04/14/2022] [Indexed: 11/25/2022] Open
Abstract
Background Genicular nerve radiofrequency ablation (RFA) is an effective, minimally invasive procedure often used to treat patients with intractable knee pain secondary to knee osteoarthritis and failed knee replacements. The prevalence of knee pain in adults has been estimated to be as high as 40% and is continuously increasing with an aging population. Over the past two decades, proceduralists have adopted variations in patient preparation, procedural steps, and post-operative care for genicular nerve RFA procedures. A survey was dispensed via the American Society of Pain and Neuroscience (ASPN) to gain a popular assessment of common practices for genicular nerve RFA. Methods A 29 question survey was dispensed via SurveyMonkey to all members of ASPN. Members were able to respond to the survey a single time and were unable to make changes to their responses once the survey was submitted. After responses were compiled, each question was assessed in order to determine common practices for genicular nerve RFA. Results A total of 378 proceduralists responded to the survey. There was high consensus with the three most commonly targeted nerves. The inferomedial, superomedial, and superolateral genicular branches were treated by 95–96% of respondents, while other targets were less commonly treated. There remains some debate among proceduralists regarding the need for a second diagnostic nerve block and the type of steroid used for diagnostic nerve blocks. Conclusion Pain physicians use a wide variety of methods to perform genicular nerve ablations. The data offered by the survey show that there is no standardized protocol when it comes to treating knee pain via genicular nerve block and ablation and highlights controversies among proceduralists that ought to serve as the targets of future clinical research aimed at establishing a standardized protocol.
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Affiliation(s)
- Alaa Abd-Elsayed
- University of Wisconsin, School of Medicine and Public Health, Department of Anesthesiology, Madison, WI, USA
- Correspondence: Alaa Abd-Elsayed, University of Wisconsin School of Medicine and Public Health, Department of Anesthesiology, 600 Highland Avenue, B6/319 CSC, Madison, WI, 53792-3272, USA, Tel +1 608-263-8100, Fax +1 608-263-0575, Email
| | - Natalie Strand
- Division of Pain Medicine, Mayo Clinic, Phoenix, AZ, USA
| | | | - Joshua Martens
- University of Wisconsin, School of Medicine and Public Health, Department of Anesthesiology, Madison, WI, USA
| | | | - Dawood Sayed
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Timothy Deer
- The Spine and Nerve Center of the Virginias, Charleston, WV, USA
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Michalowski A, Haines A, Shaparin N, Gritsenko K, Kaye AD, Cornett EM, Lerner MZ. Transcutaneous Electrical Nerve Stimulation as a Treatment for Neuropathic Cough: A Tolerability and Feasibility Study. Neurol Ther 2021; 10:1127-1133. [PMID: 34002358 PMCID: PMC8571432 DOI: 10.1007/s40120-021-00255-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/01/2021] [Indexed: 12/24/2022] Open
Abstract
Transcutaneous electrical nerve stimulation (TENS) is a form of electroanalgesia used for neuropathic pain disorders. Refractory chronic cough, or “neuropathic cough,” may be physiologically similar to other neuropathic pain conditions. This study explored the tolerability and feasibility of using TENS as a treatment for neuropathic cough. Laryngeal TENS was administered to five subjects with neuropathic cough. One electrode was placed over the lateral thyrohyoid membrane, and a second over the cricothyroid space. A frequency of 120 Hz was applied for 30 min. Participants rated symptoms pre-, during, and post-TENS treatment using a Likert scale. Laryngeal TENS was well tolerated by all subjects. Adverse effects included brief neck discomfort when increasing TENS intensity and an event of mild post-treatment hoarseness. The self-reported scores trended toward a reduction in symptom severity during and after treatment. Controlled trials using this method would elucidate the use of TENS for treatment of patients suffering from chronic cough.
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Affiliation(s)
| | - Adam Haines
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Naum Shaparin
- Department of Anesthesiology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Karina Gritsenko
- Department of Anesthesiology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Alan D Kaye
- Department of Anesthesiology, LSU Health Shreveport, Shreveport, LA, USA
| | - Elyse M Cornett
- Department of Anesthesiology, LSU Health Shreveport, Shreveport, LA, USA
| | - Michael Z Lerner
- Division of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, CT, USA.
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Abstract
Objective: Review the analgesic effect of the transversus abdominis plane (TAP) block and its impact on postoperative pain scores and opioid usage for patients undergoing laparoscopic and robotic hysterectomies. Methods: Systematic review with meta-analysis of randomized controlled trials that compared the effect of TAP block to either placebo or no block on narcotic use (in morphine equivalent units [MEq]) and pain (per visual analog scale) within 24] h after a laparoscopic or robotic hysterectomy for benign or malignant indications. Searches were conducted in PubMed and Embase through May 31, 2019. Results: Nine randomized controlled trials met eligibility criteria; 7 evaluated laparoscopic hysterectomy and 2 robotic hysterectomy. A total of 688 subjects were included (559 laparoscopic hysterectomy, 129 robotic hysterectomy). Opioid consumption was similar in the first 24] h postoperative with or without TAP block (−0.8 MEq; 95% CI, −2.9, 1.3; 8 TAP arms; N] = 395). Pain scores (visual analog scale) were also similar with or without TAP block (−0.01 U; 95% CI, −0.34, 0.32; 10 TAP arms; N] = 636). Neither meta-analysis showed statistical heterogeneity across studies. Conclusions: The evidence does not support a benefit of TAP block to reduce pain or opioid use for patients receiving laparoscopic or robotic hysterectomies.
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Affiliation(s)
- Ja Hyun Shin
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Weill Cornell Medical Center/New York Presbyterian Hospital, New York, NY
| | - Ethan M Balk
- Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, RI
| | - Karina Gritsenko
- Division of Pain Management and Regional Anesthesia, Department of Anesthesiology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY
| | - Alexander Wang
- Division of Surgery, Gynecology Section, Orlando VA Medical Center, University of Central Florida College of Medicine/Hospital Corporation of America Graduate Medical Education Consortium Obstetrics and Gynecology Residency Program, Orlando, FL
| | - Kari Plewniak
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY
| | - Naum Shaparin
- Division of Pain Management and Regional Anesthesia, Department of Anesthesiology, Albert Einstein College of Medicine/Montefiore Medical Center. Bronx, NY
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Scemama P, Farah F, Mann G, Margulis R, Gritsenko K, Shaparin N. Considerations for Epidural Blood Patch and Other Postdural Puncture Headache Treatments in Patients with COVID-19. Pain Physician 2020; 23:S305-S310. [PMID: 32942790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND A primary concern in the use of EBP in these patients is the possibility of seeding the virus in the CNS. Another important concern is related to the known hypercoagulable state in COVID-19 positive patients and associated organ dysfunction that may alter the metabolism of anticoagulants. The safety of the providers performing the EBP, the position of the patient and choices for image guidance (blind, fluoroscopic) are also key considerations to review. It is also important to explore the current state of knowledge about using allogenic instead of autologous blood as well as emerging techniques to eliminate the coronavirus from the blood. OBJECTIVES In this article we pose the questions of how to manage PDPH in the COVID-19 positive patient and more specifically, the use of epidural blood patch (EBP). METHODS Literature review. RESULTS EBP is usually considered after the failure of conservative and pharmacological treatments. Because of the additional risks of EBP in COVID-19 patients it is important to also consider less traditional pharmacological treatments such as theophylinnes and cosyntropin that may offer some additional benefit for COVID-19 patient. Finally, other interventions other than EBP should also be considered including occipital nerve blocks, sphenopalatine ganglion blocks (infratemporal or transnasal). LIMITATIONS A narrative review with paucity of literature. CONCLUSION Going forward, an effective treatment for COVID-19 or a safe vaccine and a deeper understanding of the pathophysiology of the virus will certainly change the risk calculus involved in performing an EBP in a COVID-19 patient.
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Affiliation(s)
- Pascal Scemama
- University of Massachusetts Medical School, Worcester, MA
| | | | - Glen Mann
- Albert Einstein College of Medicine; Children's Hospital at Montefiore
| | | | | | - Naum Shaparin
- Montefiore Medical Center Multidisciplinary Pain Program, Bronx, NY; Albert Einstein College of Medicine; Bronx, NY
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Woodworth G, Maniker RB, Spofford CM, Ivie R, Lunden NI, Machi AT, Elkassabany NM, Gritsenko K, Kukreja P, Vlassakov K, Tedore T, Schroeder K, Missair A, Herrick M, Shepler J, Wilson EH, Horn JL, Barrington M. Anesthesia residency training in regional anesthesiology and acute pain medicine: a competency-based model curriculum. Reg Anesth Pain Med 2020; 45:660-667. [DOI: 10.1136/rapm-2020-101480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 05/08/2020] [Accepted: 05/08/2020] [Indexed: 11/03/2022]
Abstract
The Accreditation Council for Graduate Medical Education has shifted to competency-based medical education. This educational framework requires the description of educational outcomes based on the knowledge, skills and behaviors expected of competent trainees. It also requires an assessment program to provide formative feedback to trainees as they progress to competency in each outcome. Critical to the success of a curriculum is its practical implementation. This article describes the development of model curricula for anesthesiology residency training in regional anesthesia and acute pain medicine (core and advanced) using a competency-based framework. We further describe how the curricula were distributed through a shared web-based platform and mobile application.
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Gritsenko K, Helander E, Webb MPK, Okeagu CN, Hyatali F, Renschler JS, Anzalone F, Cornett EM, Urman RD, Kaye AD. Preoperative frailty assessment combined with prehabilitation and nutrition strategies: Emerging concepts and clinical outcomes. Best Pract Res Clin Anaesthesiol 2020; 34:199-212. [PMID: 32711829 DOI: 10.1016/j.bpa.2020.04.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 04/17/2020] [Indexed: 12/11/2022]
Abstract
Important elements of the preoperative assessment that should be addressed for the older adult population include frailty, comorbidities, nutritional status, cognition, and medications. Frailty has emerged as a plausible predictor of adverse outcomes after surgery. It is present in older patients and is characterized by multisystem physiologic decline, increased vulnerability to stressors, and adverse clinical outcomes. Preoperative preparation may include a prehabilitation program, which aims to address nutritional insufficiencies, modify chronic polypharmacy, and enhance physical and respiratory conditions prior to hospital admission. Special considerations are taken for particularly high-risk patients, where the approach to prehabilitation can address specific, individual risk factors. Identifying patients who are nutritionally deficient allows practitioners to intervene preoperatively to optimize their nutritional status, and different strategies are available, such as immunonutrition. Previous studies have shown an association between increased frailty and the risk of postoperative complications, morbidity, hospital length of stay, and 30-day and long-term mortality following general surgical procedures. Evidence from numerous studies suggests a potential benefit of including a standard assessment of frailty as part of the preoperative workup of older adult patients. Studies addressing validated frailty assessments and the quantification of their predictive capabilities in various surgeries are warranted.
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Affiliation(s)
- Karina Gritsenko
- Family & Social Medicine, and Physical Medicine & Rehabilitation. Program Director, Regional Anesthesia and Acute Pain Medicine Fellowship, Montefiore Medical Center, Montefiore Multidisciplinary Pain Program. Department of Anesthesiology. 1250 Waters Place, Tower II, 8th Floor, Bronx, NY 10461, USA.
| | - Erik Helander
- Department of Anesthesiology, LSU Health Sciences Center, 1542 Tulane Avenue, New Orleans, LA 70112, USA.
| | - Michael P K Webb
- Department of Anaesthesia and Pain Medicine, Counties Manukau Health, Hospital Road, Otahuhu, Auckland 1640, New Zealand.
| | - Chikezie N Okeagu
- Department of Anesthesiology, LSU Health Sciences Center, 1542 Tulane Avenue, New Orleans, LA 70112, USA.
| | - Farees Hyatali
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport LA 71103, USA.
| | - Jordan S Renschler
- Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA.
| | | | - Elyse M Cornett
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport LA 71103, USA.
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA.
| | - Alan D Kaye
- Departments of Anesthesiology and Pharmacology, Toxicology, and Neurosciences; Provost, Chief Academic Officer, and Vice Chancellor of Academic Affairs, LSU Health Shreveport, 1501 Kings Highway, Shreveport LA 71103, USA.
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Zhang XL, Herzig S, Gritsenko K, Hascalovici J, Dua S, Shaparin N. Needle-Through-Needle Technique in Lumbar Interlaminar Epidural Steroid Injection: A Case Report. Pain Pract 2020; 20:777-779. [PMID: 32281719 DOI: 10.1111/papr.12897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 03/30/2020] [Accepted: 03/31/2020] [Indexed: 11/29/2022]
Abstract
When performing lumbar epidural steroid injection on obese patients, needle placement can be challenging due to the difficulty in estimating the appropriate needle length to utilize. Often times, the standard 3.5-inch Tuohy needle is too short to reach its target. In our case report, a needle-through-needle technique was attempted in a lumbar interlaminar epidural steroid injection procedure after the initial needle fell short of the epidural space. To avoid removing the initial needle and restarting the procedure using a longer needle, a 20-gauge 6-inch Tuohy needle was inserted into the 17-gauge 3.5-inch Tuohy needle, successfully reaching the epidural space. This technique can facilitate quicker needle placement by avoiding the need for restarting the procedure with a longer needle. Thus, procedural time and radiation exposure may be decreased, as may patient discomfort from repeat needle insertions.
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Affiliation(s)
| | - Samuel Herzig
- Department of Anesthesiology, Montefiore Medical Center, Bronx, New York, U.S.A
| | - Karina Gritsenko
- Multidisciplinary Pain Program, Montefiore Medical Center, Bronx, New York, U.S.A
| | - Jacob Hascalovici
- Multidisciplinary Pain Program, Montefiore Medical Center, Bronx, New York, U.S.A
| | - Simran Dua
- Lambert High School, Suwanee, Georgia, U.S.A
| | - Naum Shaparin
- Multidisciplinary Pain Program, Montefiore Medical Center, Bronx, New York, U.S.A
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14
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Gritsenko K, Polshin V, Agrawal P, Nair S, Shaparin N, Gruson K, Tan-Geller M. Incidence of vocal cord paresis following ultrasound-guided interscalene nerve block: An observational cohort study. Best Pract Res Clin Anaesthesiol 2019; 33:553-558. [PMID: 31791570 DOI: 10.1016/j.bpa.2019.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 05/28/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Interscalene brachial plexus block (IBPB) has become a standard practice for perioperative analgesia for shoulder procedures. However, several side effects may occur owing to its anatomic location. We have chosen to evaluate vocal cord paresis and dysphonia following interscalene blocks. METHODS After IRB approval, eight patients undergoing arthroscopic shoulder procedures were recruited into this prospective cohort study. Following informed consent, vocal cords were assessed by standardized fiberoptic evaluation. Subsequently, IBPB was performed under ultrasound (US) guidance. Patients were re-evaluated for vocal cord changes by a repeat fiberoptic assessment one hour following IBPB. Our primary outcome measure was incidence of vocal cord immobility. RESULTS No patients had diminished vocal cord motion, dysphonia, or dysphagia. CONCLUSIONS Although larger studies are required to determine the true incidence of vocal cord paresis following US-guided IBPB, our results suggest that incidence of unwanted nerve blockade other than brachial plexus is much lower than that previously described.
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Affiliation(s)
- Karina Gritsenko
- Department of Anesthesiology and Pain Management, Montefiore Medical Center, 1250 Waters Pl, Tower II, 8th Floor, Bronx, 10461, NY, USA
| | - Victor Polshin
- Department of Anesthesiology and Perioperative Medicine, UMASS Memorial Medical Center, 119 Belmont St, Worcester, 01605, MA USA.
| | - Priya Agrawal
- Department of Anesthesiology and Pain Management, Montefiore Medical Center, 1250 Waters Pl, Tower II, 8th Floor, Bronx, 10461, NY, USA.
| | - Singh Nair
- Department of Anesthesiology and Pain Management, Montefiore Medical Center, 1250 Waters Pl, Tower II, 8th Floor, Bronx, 10461, NY, USA
| | - Naum Shaparin
- Department of Anesthesiology and Pain Management, Montefiore Medical Center, 1250 Waters Pl, Tower II, 8th Floor, Bronx, 10461, NY, USA
| | - Konrad Gruson
- Department of Orthopedics, Department of Anesthesiology and Pain Management, Montefiore Medical Center, 1250 Waters Pl, 11th Floor, Suite B, Bronx, 10461, NY, USA.
| | - Melin Tan-Geller
- Department of Otolaryngology, Montefiore Medical Center, 222 Bloomingdale Rd, Suite 205, White Plains, 10605, Bronx, NY, USA.
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15
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Deer T, Kim P, Pope JE, Hayek S, McDowell G, Mekhail N, Diwan S, Saulino M, Moeschler S, Schultz D, Gritsenko K, Prager J, Peterson EA, Staats P, Poree L, Fishman MA, Vallejo R, Calodney A, Slavin K, Leon Cassadala O, Levy R, Buvanendran A, Sitzman BT, Sayed D, Ferrante FM, Kloth D, Gilligan CJ, Kapural L, Kloster DR, Leong M, Rosenow JM, Lamer TJ, Stearns L. Physician Guidance on the Use of Off‐Labeled Drugs in Intrathecal Drug Delivery Systems for Chronic Pain. Neuromodulation 2019; 22:765-768. [DOI: 10.1111/ner.12961] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 03/04/2019] [Accepted: 03/06/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Timothy Deer
- The Spine and Nerve Center of The Virginia Charleston WV USA
| | - Phillip Kim
- Center for Interventional Pain Spine, LLC Bryn Mawr PA USA
| | - Jason E. Pope
- Evolve Restorative CenterCalifornia Society of Interventional Pain Society Santa Rosa CA USA
| | - Salim Hayek
- Department of AnesthesiologyCase Western Reserve University, Division of Pain Medicine, University Hospital of Cleveland Cleveland OH USA
| | | | - Nagy Mekhail
- Evidence‐Based Pain Management Research, Cleveland Clinic Cleveland OH USA
| | | | | | - Susan Moeschler
- Department of Anesthesiology and Perioperative MedicineMayo Clinic Rochester MN USA
| | - David Schultz
- Nura Precision Pain Management, Department of AnesthesiologyUniversity of Minnesota Minneapolis MN USA
| | - Karina Gritsenko
- Regional Anesthesia and Acute Pain Medicine Fellowship, Department of Anesthesiology, Family & Social Medicine, and Physical Medicine & Rehabilitation, Montefiore Medical CenterMontefiore Multidisciplinary Pain Program Bronx MY USA
| | - Joshua Prager
- Center for the Rehabilitation of Pain Syndromes (CRPS) at UCLA, Department of Anesthesiology and Internal Medicine (Pain Medicine)David Geffen School of Medicine at UCLA Los Angeles CA USA
| | - Erika A. Peterson
- Department of NeurosurgeryFunctional and Restorative Neurosurgery, University of Arkansas for Medical Sciences Little Rock AR USA
| | | | - Lawrence Poree
- Department of Anesthesia and Perioperative Carethe North American Neuromodulation Society and the International Neuromodulation Society, UCSF Pain Management Center, University of California at San Francisco San Francisco CA USA
| | | | - Ricardo Vallejo
- Research, Millennium Pain Center, CEO, StimGenics, LLC Bloomington IL USA
| | - Aaron Calodney
- Department of Anesthesiology, Louisiana State University Health Science Center—Shreveport Shreveport LA USA
| | - Konstantin Slavin
- Department of NeurosurgeryUniversity of Illinois at Chicago Chicago IL USA
| | - Oscar Leon Cassadala
- Department of AnesthesiologyThe Jacobs School of Medicine at the University of Buffalo, Division of Pain and Oncology, Roswell Park Cancer Institute Buffalo NY USA
| | - Robert Levy
- International Neuromodulation Society Boca Raton FL USA
| | | | - B. Todd Sitzman
- North American Neuromodulation SocietyAdvanced Pain Therapy Hattiesburg MS USA
| | - Dawood Sayed
- Department of Anesthesiology and Pain MedicineThe University of Kansas Medical Center Kansas City KS USA
| | - F. Michael Ferrante
- UCLA Pain Management Center, Clinical Anesthesiology and MedicineDavid Geffen School of Medicine at UCLA Santa Monica CA USA
| | - David Kloth
- North American Neuromodulation SocietyConnecticut Pain Care Danbury CT USA
| | - Christopher J. Gilligan
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain MedicineBrigham & Women's Hospital Boston MA USA
| | | | | | - Michael Leong
- Department of NeuromodulationStanford Pain Management Center Redwood City CA USA
| | - Joshua M. Rosenow
- Functional Neurosurgery and Epilepsy SurgeryNeurosurgery, Neurology, and Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine Chicago IL USA
| | - Tim J. Lamer
- Department of Anesthesiology and Perioperative Medicine, Division of Pain MedicineMayo Clinic Rochester MN USA
| | - Lisa Stearns
- Center for Pain and Supportive Care Phoenix AZ USA
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16
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Romano C, Lloyd A, Nair S, Wang JY, Viswanathan S, Vydyanathan A, Gritsenko K, Shaparin N, Kosharskyy B. A Randomized Comparison of Pain Control and Functional Mobility between Proximal and Distal Adductor Canal Blocks for Total Knee Replacement. Anesth Essays Res 2018; 12:452-458. [PMID: 29962615 PMCID: PMC6020584 DOI: 10.4103/aer.aer_17_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Adductor canal blocks (ACBs) have become a popular technique for postoperative pain control in total knee arthroplasty patients. Proximal and distal ACB have been compared previously, but important postoperative outcomes have yet to be assessed. Aims: The primary objective of this study is to compare postoperative analgesia between proximal and distal ACB. Secondary outcomes include functional mobility, length of stay (LOS), and adverse events. Settings and Design: This study was a single-center, assessor-blinded, randomized trial. Subjects and Methods: Fifty-seven patients were randomly assigned to receive a proximal (n = 28) or distal (n = 29) ACB. A 20 mL bolus of 5 mg/mL ropivacaine was injected at the respective location followed by 2.0 mg/mL ropivacaine infusion for 24 h. Statistical Analysis: The primary outcome was intra- and postoperative 24-h opioid consumption in intravenous (IV) morphine equivalents. Secondary outcomes include percentage change in timed “Up and Go” (TUG) times, LOS, and average postoperative pain scores. Continuous variables were compared using Student's t-test. Results: The mean (±standard deviation) 24-h intra-and postoperative opioid consumption showed no difference between the proximal and distal groups (39.72 ± 23.6 and 41.28 ± 19.6 mg IV morphine equivalents, respectively, P = 0.793). There was also no significant difference in the median [minimum, maximum] percentage change in TUG times relative to preoperative performance comparing proximal and distal ACB (334.0 [131, 1084] %-change and 458.5 [169, 1696] %-change, respectively, P = 0.130). In addition, there were no differences in postoperative pain scores or LOS. Conclusions: ACB performed at either proximal or distal locations shows no difference in postoperative pain measured by opioid consumption or pain scores. Better TUG performance seen in the proximal group was not statistically significant but might represent a clinically important difference in functional mobility.
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Affiliation(s)
- Christopher Romano
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Andrew Lloyd
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Singh Nair
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jenny Y Wang
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Shankar Viswanathan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Amaresh Vydyanathan
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Karina Gritsenko
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Naum Shaparin
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Boleslav Kosharskyy
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
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17
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Vydyanathan A, Kosharskyy B, Nair S, Gritsenko K, Kim RS, Wang D, Shaparin N. The Use of Electrical Impedance to Identify Intraneural Needle Placement in Human Peripheral Nerves: A Study on Amputated Human Limbs. Anesth Analg 2017; 123:228-32. [PMID: 27314695 DOI: 10.1213/ane.0000000000001332] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Even as the use of peripheral nerve blockade in the perioperative setting is increasing, neural injury secondary to accidental intraneural injection remains a significant patient safety concern. Current modalities, including electrical stimulation and ultrasound imaging, still lack consistency and absolute reliability in both the detection and prevention of this complication. The measurement of electrical impedance (EI) could be an easy and valuable additional tool to detect intraneural needle placement. Our objectives in this study were to measure the change in EI with intraneural needle advancement in recently amputated human limbs. METHODS The study was conducted within 45 minutes of amputation. The nerves that were studied were the sciatic nerve in the popliteal fossa in above-knee amputations or the tibial nerve below the calf in below-knee amputations. The amputated limb was placed on a tray and under ultrasound imaging guidance, an insulated peripheral block needle connected to a nerve stimulator was placed extraneurally and subsequently advanced intraneurally. The experiment was repeated on the same nerve after exposure by surgical dissection. The differences in impedance measurements between intraneural and extraneural needle placement were compared. RESULTS In the below-knee amputated extremity (tibial nerve, n = 6) specimens based on the ultrasound methods, mean ± SD for ultrasound-guided intraneural impedance was 10 ± 2 kΩ compared with an extraneural impedance of 6 ± 1.6 kΩ (P = 0.005). The difference between intraneural and extraneural impedance after open dissection was also significant when we repeated the analysis based on the same specimens (P = 0.005). Similarly, in the above-the-knee amputated extremity (sciatic nerve, n = 5) specimens, mean intraneural impedance was 35.2 ± 7.9 kΩ compared with an extraneural impedance of 25.2 ± 5.3 kΩ (P = 0.037). The difference between intraneural and extraneural impedance obtained after open dissection was also significant when we repeated the analysis based on the same specimens (P = 0.0002). The impedance values were consistent and similar to those obtained after open dissection. CONCLUSIONS There is no reliable "gold standard" to predict or prevent intraneural needle placement during peripheral nerve blockade. This small sample-sized study demonstrated that there is a change in EI with intraneural needle advancement. In clinical practice, measurement of the EI in conjunction with nerve stimulation may serve as another tool to use for identifying intraneural needle placement during peripheral nerve blockade.
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Affiliation(s)
- Amaresh Vydyanathan
- From the Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
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18
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Abstract
Novel anticoagulants (NAGs) have emerged as the preferred alternatives to vitamin K antagonists. In patients being considered for regional anesthesia, these drugs present a layer of complexity in the preprocedure evaluation. There are no established tests to monitor anticoagulant activity and our experience is short with these drugs. These authors believe it is important to review the relevant hematology, orthopedics, and anesthesiology literature to provide a valuable reference for the clinician who is met with these challenges. In addition to discussing NAGs, we also review the existing American Society of Regional Anesthesia guidelines for heparin, low-molecular-weight heparin, and antiplatelet agents.
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Affiliation(s)
- Mudit Kaushal
- Department of Anesthesiology, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA
| | - Ryan E Rubin
- Department of Anesthesiology, Louisiana State University School of Medicine, 1542 Tulane Avenue, Room 658, New Orleans, LA 70112, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University School of Medicine, 1542 Tulane Avenue, Room 658, New Orleans, LA 70112, USA
| | - Karina Gritsenko
- Department of Anesthesiology, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA.
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19
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Bromberg AL, Dennis JA, Gritsenko K. Exparel/Peripheral Catheter Use in the Ambulatory Setting and Use of Peripheral Catheters Postoperatively in the Home Setting. Curr Pain Headache Rep 2017; 21:13. [PMID: 28271332 DOI: 10.1007/s11916-017-0605-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE OF REVIEW With the increasing number of ambulatory surgeries being performed, regional anesthesia has become an increasingly popular anesthetic modality, and many choices exist to provide efficient, effective quality perioperative analgesia. In this paper, we will review the various regional anesthesia options in addition to the advantages and disadvantages of each. Lastly, we will discuss liposomal bupivicaine, a long acting local anesthetic, and its future role in the anesthesiologist's armamentarium. The aim of the publication is to provide a general overview of regional anesthesia as well as to discuss the advantages and disadvantages of this modality. Additionally, we sought to review the basics of liposomal bupivicaine as well as the relevant literature. RECENT FINDINGS The results regarding liposomal bupivicaine are mixed and mainly focuses on local infiltration and intra-articular injections. There are no known studies specifically comparing liposomal bupivicaine to bupivicaine hydrochloride in ultrasound-guided nerve blocks. There is some encouraging data regarding liposomal bupivicaine, but further studies are needed before it is adopted as a mainstay of treatment. In addition to efficacy, additional investigations are needed to evaluate cost as this could be a major impediment to its implementation.
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Affiliation(s)
- Adam L Bromberg
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210 Street, 4th Floor, Bronx, NY, 10467, USA
| | - Jeremy A Dennis
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210 Street, 4th Floor, Bronx, NY, 10467, USA
| | - Karina Gritsenko
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210 Street, 4th Floor, Bronx, NY, 10467, USA. .,Department of Family & Social Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210 Street, 4th Floor, Bronx, NY, 10467, USA. .,Department of Physical Medicine and Rehabilitation, Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210 Street, 4th Floor, Bronx, NY, 10467, USA.
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20
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21
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Romanelli E, Vydynathan A, Gritsenko K. Lumbar Radicular Pain. Pain Medicine 2017. [DOI: 10.1007/978-3-319-43133-8_120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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22
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Antoine IAFJ, Gritsenko K, Carullo V. Development of Pain Systems. Pain Medicine 2017. [DOI: 10.1007/978-3-319-43133-8_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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23
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Chinn SY, Chuang E, Gritsenko K. Designing, Reporting, and Interpreting Clinical Research Studies. Pain Medicine 2017. [DOI: 10.1007/978-3-319-43133-8_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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24
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Caldwell W, Gritsenko K. Placebo and Pain. Pain Medicine 2017. [DOI: 10.1007/978-3-319-43133-8_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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25
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Shaparin N, Nguyen DM, Gritsenko K. Carpal Tunnel Syndrome. Pain Medicine 2017. [DOI: 10.1007/978-3-319-43133-8_127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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26
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Khelemsky Y, Gritsenko K, Litt J. Immunoglobulin G. Pain Medicine 2017. [DOI: 10.1007/978-3-319-43133-8_51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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27
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Aligene K, Garg AS, Gritsenko K, Khelemsky Y. Work Rehabilitation. Pain Medicine 2017. [DOI: 10.1007/978-3-319-43133-8_110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Opioid dependence can occur due to prescription opioid use, recreational opioid use, or as a result of opioid use for the treatment of drug addiction. Pain control in these patients is truly a challenge. It is important to understand the patient's condition such as the phenomenon of drug dependence, drug addiction, and pseudoaddiction to provide effective analgesia. This may be accomplished using appropriate multimodal therapies and by treatment of coexisting diseases such as anxiety. The goal is to provide effective analgesia, prevent cognitive and emotional problems, and produce a positive postoperative rehabilitation process. Multimodal options include pharmacological and nonpharmacological approaches, psychological support, and interventional pain procedures, all focused toward providing optimal pain control while preventing undertreatment, withdrawal symptoms, and other complications.
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Affiliation(s)
- Nalini Vadivelu
- Associate Professor of Anesthesiology, Department of Anesthesiology, Yale University, New Haven, Connecticut
| | - Sukanya Mitra
- Professor of Anaesthesiology, Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Alice M Kai
- Medical Student, Stony Brook School of Medicine, Stony Brook, New York
| | - Gopal Kodumudi
- Medical Student, California North State University College of Medicine, Elk Grove, California
| | - Karina Gritsenko
- Assistant Professor of Anesthesiology, Department of Anesthesiology, Pain Medicine, Regional Anesthesiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
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29
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Shaparin N, Sim A, Pappagallo M, Gritsenko K, Carullo V, Tsukanov J, Kosharskyy B. Intrathecal analgesia: time to consider it for your patient? J Fam Pract 2015; 64:166-172. [PMID: 25789343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
When systemic analgesics or antispasmodics fail to control chronic pain or cause intolerable adverse effects, an intrathecal drug delivery system may be the best bet.
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Affiliation(s)
- Naum Shaparin
- Department of Anesthesiology and Pain Management, Department of Family and Social Medicine/Palliative Medicine, Montefiore Medical Center, Bronx, NY, USA.
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30
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Gritsenko K, Khelemsky Y, Kaye AD, Vadivelu N, Urman RD. Multimodal therapy in perioperative analgesia. Best Pract Res Clin Anaesthesiol 2014; 28:59-79. [PMID: 24815967 DOI: 10.1016/j.bpa.2014.03.001] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 02/26/2014] [Accepted: 03/04/2014] [Indexed: 12/22/2022]
Abstract
This article reviews the current evidence for multimodal analgesic options for common surgical procedures. As perioperative physicians, we have come a long way from using only opioids for postoperative pain to combinations of acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), selective Cyclo-oxygenase (COX-2) inhibitors, local anesthetics, N-methyl-d-aspartate (NMDA) receptor antagonists, and regional anesthetics. As discussed in this article, many of these agents have decreased narcotic requirements, improved patient satisfaction, and decreased postanesthesia care unit (PACU) times, as well as morbidity in the perioperative period.
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Affiliation(s)
- Karina Gritsenko
- Department of Anesthesiology, Montefiore Medical Center, Bronx, New York, NY, USA; Department of Family and Social Medicine, Montefiore Medical Center, Bronx, New York, NY, USA; Acute Pain, Regional, Chronic Pain, Montefiore Medical Center, Bronx, New York, NY, USA; Albert Einstein College of Medicine, Yeshiva University, Montefiore Medical Center, Bronx, New York, NY, USA.
| | - Yury Khelemsky
- Anesthesiology, Icahn School of Medicine of Mount Sinai, New York, NY, USA; Pain Medicine Fellowship Program, Icahn School of Medicine of Mount Sinai, New York, NY, USA
| | - Alan David Kaye
- Department of Anesthesiology, LSU School of Medicine, New Orleans, LA, USA; Interventional Pain Services, LSU School of Medicine, New Orleans, LA, USA; Department of Pharmacology, LSU School of Medicine, New Orleans, LA, USA; Department of Anesthesiology, Tulane School of Medicine, New Orleans, LA, USA; Department of Pharmacology, Tulane School of Medicine, New Orleans, LA, USA
| | - Nalini Vadivelu
- Anesthesiology Department, Yale University School of Medicine, New Haven, CT, USA
| | - Richard D Urman
- Harvard Medical School, Boston, MA, USA; Department of Anesthesiology, Brigham and Women's Hospital, USA
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31
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Gritsenko K. Timing of Neuraxial Pain Interventions
Following Blood Patch for Post Dural Puncture
Headache. Pain Physician 2014. [DOI: 10.36076/ppj.2014/17/119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Post dural puncture headache (PDPH) is a common complication of interventional neuraxial
procedures. Larger needle gauge, younger patients, low body mass index, women (especially
pregnant women), and “traumatic” needle types are all associated with a higher incidence of
PDPH. Currently, an epidural blood patch is the gold-standard treatment for this complication.
However, despite the high PDPH cure rate through the use of this therapy, little is known about
the physiology behind the success of the epidural blood patch, specifically, the time course of
patch formation within the epidural space or how long it takes for the blood patch volume to
be resorbed by the body. Of the many unanswered and debated topics related to PDPH and
epidural blood patches, one additional specific question that may alter clinical management
is when it is safe for patients who have experienced a disruption of the thecal space and have
undergone this procedure to have a subsequent epidural or spinal procedure, such as a neuraxial
anesthetic (i.e. a spinal anesthetic for an elective outpatient procedure) or an interventional
pain procedure for chronic pain management. This question becomes more unclear if the
new procedure includes a steroid medication. As an example, an older patient presents with
a history of lumbar disc disease and during lumbar epidural steroid injection, an inadvertent
wet tap occurs leading to PDPH. Following management with fluids, caffeine, medications,
and a successful epidural blood patch, it remains unclear as to when would be the best time
frame to consider a second lumbar epidural steroid injection. We identified the 3 main risk
factors of subsequent interventional neuraxial procedures as (1) disruption of the epidural blood
patch and ongoing reparative processes, (2) epidural procedure failure, and (3) infection. We
looked at the literature, and summarized the existing literature in order to enable health care
professionals to understand the time course of dural repair as well as the risks of subsequent
neuraxial procedures after epidural blood patches. This review poses the question using an
evidence based review to discuss the appropriate time course to proceed.
Key words: Post dural puncture headache, epidural steroid injection, wet tap, timing of
therapy
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Affiliation(s)
- Karina Gritsenko
- Montefiore Medical Center/ Albert Einstein College of Medicine, Bronx, New York
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Shaparin N, Gritsenko K, Shapiro D, Kosharskyy B, Kaye AD, Smith HS. Timing of neuraxial pain interventions following blood patch for post dural puncture headache. Pain Physician 2014; 17:119-125. [PMID: 24658472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Post dural puncture headache (PDPH) is a common complication of interventional neuraxial procedures. Larger needle gauge, younger patients, low body mass index, women (especially pregnant women), and "traumatic" needle types are all associated with a higher incidence of PDPH. Currently, an epidural blood patch is the gold-standard treatment for this complication. However, despite the high PDPH cure rate through the use of this therapy, little is known about the physiology behind the success of the epidural blood patch, specifically, the time course of patch formation within the epidural space or how long it takes for the blood patch volume to be resorbed by the body. Of the many unanswered and debated topics related to PDPH and epidural blood patches, one additional specific question that may alter clinical management is when it is safe for patients who have experienced a disruption of the thecal space and have undergone this procedure to have a subsequent epidural or spinal procedure, such as a neuraxial anesthetic (i.e. a spinal anesthetic for an elective outpatient procedure) or an interventional pain procedure for chronic pain management. This question becomes more unclear if the new procedure includes a steroid medication. As an example, an older patient presents with a history of lumbar disc disease and during lumbar epidural steroid injection, an inadvertent wet tap occurs leading to PDPH. Following management with fluids, caffeine, medications, and a successful epidural blood patch, it remains unclear as to when would be the best time frame to consider a second lumbar epidural steroid injection. We identified the 3 main risk factors of subsequent interventional neuraxial procedures as (1) disruption of the epidural blood patch and ongoing reparative processes, (2) epidural procedure failure, and (3) infection. We looked at the literature, and summarized the existing literature in order to enable health care professionals to understand the time course of dural repair as well as the risks of subsequent neuraxial procedures after epidural blood patches. This review poses the question using an evidence based review to discuss the appropriate time course to proceed.
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Affiliation(s)
| | - Karina Gritsenko
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York; The Mount Sinai Medical Center/Icahn School of Medicine at Mount Sinai, New York, NY; Louisiana State University School of Medicine, New Orleans; Albany Medical College
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Abstract
Tinnitus is described as an auditory phantom perception analogous to central neuropathic pain.
Despite the high prevalence of this debilitating symptom, no intervention is recognized that reliably
eliminates tinnitus symptoms; a cause has yet to be determined.
A 65-year-old healthy man presented with a 3 year history of left-sided tinnitus. Full workup
performed by the primary care physician including blood tests for electrolyte imbalance,
consultations by 2 independent otholaryngologists, and imaging did not reveal abnormalities to
provide etiology of the tinnitus. No other complaints were noted except for occasional minimal left
sided neck pain. Cervical spine x-ray showed degenerative changes with facet hypertrophy more
pronounced on the left side.
Subsequently, the patient underwent diagnostic left-sided C2-C3 medial branch block, resulting
in complete resolution of tinnitus for more than 6 hours. After successful radiofrequency ablation
of left C2-C3 medial branches, the patient became asymptomatic. At one year follow-up, he
continued to be symptom free.
Sparce studies have shown interaction between the somatosensory and auditory system at dorsal
cochlear nucleus (DCN), inferior colliculus, and parietal association areas. Upper cervical nerve
(C2) electrical stimulation evokes potentials in the DCN, eliciting strong patterns of inhibition and
weak excitation of the DCN principal cells. New evidence demonstrated successful transcutaneous
electrical nerve stimulation (TENS) of upper cervical nerve (C2) for treatment of somatic tinnitus in
240 patients. This case indicates that C2-C3 facet arthropathy may cause tinnitus and radiofrequency
ablation of C2-C3 medial branches can provide an effective approach not previously considered.
Key words: Radiofrequency ablation, tinnitus, neuropathic pain, cervical medial branch block,
cervical pain, auditory phantom perception
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Affiliation(s)
- Karina Gritsenko
- Department of Anesthesiology Division of Pain Medicine Montefiore Medical Center/ Albert Einstein College of Medicine, Bronx, NY
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Gritsenko K, Caldwell W, Shaparin N, Vydyanathan A, Kosharskyy B. Resolution of long standing tinnitus following radiofrequency ablation of C2-C3 medial branches--a case report. Pain Physician 2014; 17:E95-E98. [PMID: 24452662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Tinnitus is described as an auditory phantom perception analogous to central neuropathic pain. Despite the high prevalence of this debilitating symptom, no intervention is recognized that reliably eliminates tinnitus symptoms; a cause has yet to be determined. A 65-year-old healthy man presented with a 3 year history of left-sided tinnitus. Full workup performed by the primary care physician including blood tests for electrolyte imbalance, consultations by 2 independent otholaryngologists, and imaging did not reveal abnormalities to provide etiology of the tinnitus. No other complaints were noted except for occasional minimal left sided neck pain. Cervical spine x-ray showed degenerative changes with facet hypertrophy more pronounced on the left side. Subsequently, the patient underwent diagnostic left-sided C2-C3 medial branch block, resulting in complete resolution of tinnitus for more than 6 hours. After successful radiofrequency ablation of left C2-C3 medial branches, the patient became asymptomatic. At one year follow-up, he continued to be symptom free. Sparce studies have shown interaction between the somatosensory and auditory system at dorsal cochlear nucleus (DCN), inferior colliculus, and parietal association areas. Upper cervical nerve (C2) electrical stimulation evokes potentials in the DCN, eliciting strong patterns of inhibition and weak excitation of the DCN principal cells. New evidence demonstrated successful transcutaneous electrical nerve stimulation (TENS) of upper cervical nerve (C2) for treatment of somatic tinnitus in 240 patients. This case indicates that C2-C3 facet arthropathy may cause tinnitus and radiofrequency ablation of C2-C3 medial branches can provide an effective approach not previously considered.
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Affiliation(s)
- Karina Gritsenko
- Department of Anesthesiology Division of Pain Medicine Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
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Gritsenko K, Marcello D, Liguori GA, Jules-Elysée K, Memtsoudis SG. Meningitis or epidural abscesses after neuraxial block for removal of infected hip or knee prostheses. Br J Anaesth 2012; 108:485-90. [PMID: 22180468 DOI: 10.1093/bja/aer416] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Infection, whether localized or systemic, can be a relative contraindication to neuraxial anaesthesia. Data correlating neuraxial anaesthesia and the development of meningitis or epidural abscess in this setting are limited. METHODS Retrospective chart review was performed on 710 medical records of patients admitted between 1998 and 2009 for removal of potentially infected total hip and total knee prostheses. Ultimately, 474 patients were identified as being infected. Factors that predisposed a patient to an immunocompromised state, and signs and symptoms of infection in the pre-, intra-, and postoperative stages were documented. Bacteraemic patients were reviewed for signs of neuraxial infection. The endpoint of follow-up was development of complications before hospital discharge. RESULTS All 474 patients had removal of the infected prosthesis under neuraxial anaesthesia. Mean patient age was 65.5 yr (58% >65 yr) and mean length of hospital stay was 21 days. Patient characteristics included concurrent disease (65%), steroid use (5.3%), preoperative antibiotic use (50.8%), signs of inflammatory process (84%), bacteraemia (4.2%), and documented positive intraoperative joint cultures (88%). Using clinical standards for diagnosis of central neuraxial infection, patients developed infectious complications (incidence of 0.6% on 95% confidence interval), although three patients had findings attributable to anaesthesia, including epidural haematoma, psoas abscess, and back pain. CONCLUSIONS Based on clinical criteria, our findings suggest that the incidence of central nervous system infection after neuraxial anaesthesia in patients with infected hip and knee prostheses is low after neuraxial block.
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Affiliation(s)
- K Gritsenko
- Department of Anesthesiology, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
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